SUMMARY On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.
{"title":"Pharmacological management of psychopathology in people with intellectual disabilities and/or autism spectrum disorder","authors":"S. Deb, M. Roy, B. Limbu","doi":"10.1192/bja.2022.61","DOIUrl":"https://doi.org/10.1192/bja.2022.61","url":null,"abstract":"SUMMARY On average, 49–63% of people with intellectual disabilities and/or autism spectrum disorder (ASD) are prescribed psychotropic medications to treat psychopathology, including psychiatric illness, behaviours that challenge and the core symptoms and associated behaviours of these developmental disorders. In many cases, psychotropics, particularly antipsychotics, are used off-label without a proper indication, particularly to manage behaviours that challenge. The RCTs show moderate evidence supporting the efficacy of low-dose risperidone and some preliminary evidence for aripiprazole in treating behaviours that challenge among children with ASD and/or intellectual disabilities. The RCT-based evidence for the other psychotropics is equivocal, so no definitive conclusions can be made on their efficacy. Polypharmacy and the use of high doses of antipsychotics are prevalent in this population, leading to the risk of adverse events and drug–drug interactions. Despite various national and international guidelines, and government initiatives encouraging reduced psychotropic use, there is little evidence of this happening; on the contrary, the use of antidepressants, mood stabilisers and benzodiazepines may be increasing. A concerted multi-agency effort is urgently needed to address this significant public health concern of the overmedication of people with intellectual disabilities and/or ASD.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"44 1","pages":"322 - 333"},"PeriodicalIF":1.3,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73833030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Risk assessment in clinical practice is often characterised as a process of analysing information so as to make a judgement about the likelihood of harmful behaviour occurring in the future. However, this characterisation is brought into question when the evidence does not support the current use of risk assessment approaches to predict, or provide probability estimates of, future behaviour in a way that is usable in single instances arising in individual cases. This article sets out a broader and more clinically applicable description of risk assessment which takes account of the wider influences on how this clinical activity takes place. In so doing, it provides a framework to guide clinicians, researchers and authors of practice guidance who are interested in improving approaches to risk assessment.
{"title":"Risk assessment in clinical practice: a framework for decision-making in real-world complex systems","authors":"R. Nathan, S. Bhandari","doi":"10.1192/bja.2022.67","DOIUrl":"https://doi.org/10.1192/bja.2022.67","url":null,"abstract":"\u0000 Risk assessment in clinical practice is often characterised as a process of analysing information so as to make a judgement about the likelihood of harmful behaviour occurring in the future. However, this characterisation is brought into question when the evidence does not support the current use of risk assessment approaches to predict, or provide probability estimates of, future behaviour in a way that is usable in single instances arising in individual cases. This article sets out a broader and more clinically applicable description of risk assessment which takes account of the wider influences on how this clinical activity takes place. In so doing, it provides a framework to guide clinicians, researchers and authors of practice guidance who are interested in improving approaches to risk assessment.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"33 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89430285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Challenging behaviours often co-occur at high rates among those with autism spectrum disorder and intellectual disability. Challenging behaviours, including self-injury, aggression and property destruction, can be associated with social impairment and increased caregiver demands and stress. These behaviours often arise from and are maintained by a combination of biological and environmental risk factors throughout the lifespan. Given the impact of challenging behaviours on development, function-based assessment and intervention approaches are crucial. The prevalence, risk factors, assessment tools and evidence-based treatment options utilised for individuals with developmental disorders are discussed.
{"title":"Challenging behaviour in children with developmental disabilities: an overview of behavioural assessment and treatment methods","authors":"Celeste Tevis, J. Matson","doi":"10.1192/bja.2022.59","DOIUrl":"https://doi.org/10.1192/bja.2022.59","url":null,"abstract":"SUMMARY Challenging behaviours often co-occur at high rates among those with autism spectrum disorder and intellectual disability. Challenging behaviours, including self-injury, aggression and property destruction, can be associated with social impairment and increased caregiver demands and stress. These behaviours often arise from and are maintained by a combination of biological and environmental risk factors throughout the lifespan. Given the impact of challenging behaviours on development, function-based assessment and intervention approaches are crucial. The prevalence, risk factors, assessment tools and evidence-based treatment options utilised for individuals with developmental disorders are discussed.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"13 1","pages":"401 - 409"},"PeriodicalIF":1.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89645875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinicians should be aware of the inherent jurisdiction of the High Court in providing a ‘safety net’ to protect ‘vulnerable’ adults who are not within the scope of the Mental Capacity Act 2005 (MCA) or the Mental Health Act (MHA) 1983. Many situations in which the inherent jurisdiction has been deployed have been to safeguard vulnerable adults where there is abuse, coercion or undue influence, but the person does not lack decision-making capacity under the MCA. We explain the nature of the inherent jurisdiction, including descriptions of concepts surrounding ‘vulnerability’; as an intervention of last resort, we consider what statutory alternatives may exist, including safeguarding law under the Care Act 2014; we discuss decision-making capacity in relation to contact with others and, using real cases, the types of order that may be made under the court's inherent jurisdiction. It is important to be mindful that although there may be a legal remedy to safeguard this ‘vulnerable but capacitous’ group, there is a delicate and challenging balance between protecting those at risk and respecting their autonomy.
{"title":"The great safety net: the inherent jurisdiction and vulnerable adults","authors":"N. Brindle, Z. Jawaid, Michael Kennedy","doi":"10.1192/bja.2022.58","DOIUrl":"https://doi.org/10.1192/bja.2022.58","url":null,"abstract":"\u0000 Clinicians should be aware of the inherent jurisdiction of the High Court in providing a ‘safety net’ to protect ‘vulnerable’ adults who are not within the scope of the Mental Capacity Act 2005 (MCA) or the Mental Health Act (MHA) 1983. Many situations in which the inherent jurisdiction has been deployed have been to safeguard vulnerable adults where there is abuse, coercion or undue influence, but the person does not lack decision-making capacity under the MCA. We explain the nature of the inherent jurisdiction, including descriptions of concepts surrounding ‘vulnerability’; as an intervention of last resort, we consider what statutory alternatives may exist, including safeguarding law under the Care Act 2014; we discuss decision-making capacity in relation to contact with others and, using real cases, the types of order that may be made under the court's inherent jurisdiction. It is important to be mindful that although there may be a legal remedy to safeguard this ‘vulnerable but capacitous’ group, there is a delicate and challenging balance between protecting those at risk and respecting their autonomy.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"48 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76892975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Tracy, R. Gadelrab, A. Rahim, Gabrielle Pendlebury, Hashim Reza, R. Bhattacharya, Asif M. Bachlani, K. Worlley, David Rigby, Maria Heath, S. Dave
‘Digital’ is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing.
{"title":"Digital literacy in contemporary mental healthcare: online assessments and mobile health apps","authors":"D. Tracy, R. Gadelrab, A. Rahim, Gabrielle Pendlebury, Hashim Reza, R. Bhattacharya, Asif M. Bachlani, K. Worlley, David Rigby, Maria Heath, S. Dave","doi":"10.1192/bja.2022.60","DOIUrl":"https://doi.org/10.1192/bja.2022.60","url":null,"abstract":"\u0000 ‘Digital’ is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"11 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90225959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B CPD credits: b 0.5 Other recently published CPD eLearning podcasts (each worth 0.5 CPD credits and freely accessible) include: • Are you ignorant about the pandemic? CPD eLearning (formerly CPD Online) is a resource provided by the Royal College of Psychiatrists for mental health professionals, housed on our new eLearning Hub. For more information, visit CPD eLearning on the eLearning Hub: https://elearninghub.rcpsych.ac.uk I BJPsych Advances i and CPD eLearning work together to produce regular joint commissions to enhance learning for mental health professionals. [Extracted from the article] Copyright of BJPsych Advances is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
{"title":"New from CPD eLearning","authors":"","doi":"10.1192/bja.2022.57","DOIUrl":"https://doi.org/10.1192/bja.2022.57","url":null,"abstract":"B CPD credits: b 0.5 Other recently published CPD eLearning podcasts (each worth 0.5 CPD credits and freely accessible) include: • Are you ignorant about the pandemic? CPD eLearning (formerly CPD Online) is a resource provided by the Royal College of Psychiatrists for mental health professionals, housed on our new eLearning Hub. For more information, visit CPD eLearning on the eLearning Hub: https://elearninghub.rcpsych.ac.uk I BJPsych Advances i and CPD eLearning work together to produce regular joint commissions to enhance learning for mental health professionals. [Extracted from the article] Copyright of BJPsych Advances is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"12 1","pages":"279 - 279"},"PeriodicalIF":1.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79504863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Javier Ortiz-Orendain, S. Covarrubias-Castillo, A. O. Vázquez-Álvarez, Santiago Castiello-de Obeso, Gustavo E. Arias Quiñones, Maya Seegers, L. Colunga-Lozano, Noura Al-Juffali, M. Horowitz, David Taylor, G. Malhi, Erica Bell, Idura N. Hisham, Jacqueline Sin, K. Rouf, Danny Taggart, Giles Townsend, Angela Sweeney, Claire A. Wilson, Shirley McNicholas, Emina Redzic, Maneek Sahota, Vincent Kirchner, Gerrit Glas
{"title":"BJA volume 28 issue 5 Cover and Back matter","authors":"Javier Ortiz-Orendain, S. Covarrubias-Castillo, A. O. Vázquez-Álvarez, Santiago Castiello-de Obeso, Gustavo E. Arias Quiñones, Maya Seegers, L. Colunga-Lozano, Noura Al-Juffali, M. Horowitz, David Taylor, G. Malhi, Erica Bell, Idura N. Hisham, Jacqueline Sin, K. Rouf, Danny Taggart, Giles Townsend, Angela Sweeney, Claire A. Wilson, Shirley McNicholas, Emina Redzic, Maneek Sahota, Vincent Kirchner, Gerrit Glas","doi":"10.1192/bja.2022.56","DOIUrl":"https://doi.org/10.1192/bja.2022.56","url":null,"abstract":"","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"3 1","pages":"b1 - b2"},"PeriodicalIF":1.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82931620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Antipsychotics are the cornerstone of schizophrenia management but they are not adequate in treating the negative and cognitive symptoms of the illness. The Cochrane review discussed in this commentary examines the safety and effectiveness of the wakefulness-promoting agent, modafinil, as an adjunct to standard care in the mitigation of negative and cognitive symptoms of schizophrenia. Add-on modafinil, compared to add-on placebo and standard treatment, did not result in a clear benefit. Due to the heterogenous body of evidence, the quality of which ranged from very low to moderate, the review's conclusions are equivocal.
{"title":"Is modafinil an effective adjunct to standard care in the treatment of schizophrenia-spectrum disorders?","authors":"M. Oyesanya, N. Al-Juffali","doi":"10.1192/bja.2022.36","DOIUrl":"https://doi.org/10.1192/bja.2022.36","url":null,"abstract":"SUMMARY Antipsychotics are the cornerstone of schizophrenia management but they are not adequate in treating the negative and cognitive symptoms of the illness. The Cochrane review discussed in this commentary examines the safety and effectiveness of the wakefulness-promoting agent, modafinil, as an adjunct to standard care in the mitigation of negative and cognitive symptoms of schizophrenia. Add-on modafinil, compared to add-on placebo and standard treatment, did not result in a clear benefit. Due to the heterogenous body of evidence, the quality of which ranged from very low to moderate, the review's conclusions are equivocal.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"71 1","pages":"281 - 285"},"PeriodicalIF":1.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73888348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. James, S. Morris, Allanah Johnston, Danny Glover
There are many pressures on elite footballers. They work in a meritocracy, where only the best are selected and play at the highest levels. From the moment they enter an academy to their retirement there is a fear of deselection and rejection. Elite players need to contend with criticisms from fans and via social media; team and management dynamics can be stressful. Fears of injury are major concerns. In addition, the players are likely to face everyday difficulties experienced by the rest of society, such as relationship, family and financial problems. There is a great deal of stigma associated with mental health problems in footballers, hence approaches are required that are destigmatising. This article presents two frameworks conceptualising stress in footballers: the Power Threat Meaning Framework, which describes stress in non-diagnostic terms; and the Yerkes–Dodson curve, which describes how stress can affect footballers’ mental and physical performances on the pitch. Both frameworks can combine to enable therapists to understand players’ distress and its impact and to guide towards appropriate treatments, as we show in a fictitious case study.
{"title":"Treating mental stress in elite footballers using a stigma-free psychological approach: the Power Threat Meaning Framework","authors":"I. James, S. Morris, Allanah Johnston, Danny Glover","doi":"10.1192/bja.2022.48","DOIUrl":"https://doi.org/10.1192/bja.2022.48","url":null,"abstract":"\u0000 There are many pressures on elite footballers. They work in a meritocracy, where only the best are selected and play at the highest levels. From the moment they enter an academy to their retirement there is a fear of deselection and rejection. Elite players need to contend with criticisms from fans and via social media; team and management dynamics can be stressful. Fears of injury are major concerns. In addition, the players are likely to face everyday difficulties experienced by the rest of society, such as relationship, family and financial problems. There is a great deal of stigma associated with mental health problems in footballers, hence approaches are required that are destigmatising. This article presents two frameworks conceptualising stress in footballers: the Power Threat Meaning Framework, which describes stress in non-diagnostic terms; and the Yerkes–Dodson curve, which describes how stress can affect footballers’ mental and physical performances on the pitch. Both frameworks can combine to enable therapists to understand players’ distress and its impact and to guide towards appropriate treatments, as we show in a fictitious case study.","PeriodicalId":9336,"journal":{"name":"BJPsych Advances","volume":"9 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88232811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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